983 kB 21st May 2014 NationalFormulary

Transcription

983 kB 21st May 2014 NationalFormulary
KEEPING HEALTH CARE BENEFITS AFFORDABLE WITH
“FORMULARY” COVERAGE
Of all the products and services covered under your Chambers of Commerce Group Insurance
Plan® health care benefit, prescription drug costs account for 70¢ of every claim dollar. One
successful way to manage increasing costs is through the use of a Formulary. The Chambers
Plan offers the TELUS Health Solutions National Formulary as part of some health coverage
options. While we offer a wide range of health care options, we recommend you seriously
consider whether a Formulary option can work for you!
WHAT IS A FORMULARY?
A formulary is an actively managed, evolving list defining the
prescription drugs to be covered under your company’s benefit program.
The list is designed to minimize the impact of rising drug costs by
covering only drugs that are both medicinally effective and cost effective.
For years now, Canadian hospitals and provincial drug plans have used
formularies successfully.
TELUS Health Solutions operates the largest private electronic insurance
claims network in Canada. With continued input from ReVue, an
independent committee of physicians and pharmacists, TELUS Health
Solutions constantly reviews the items included in the National
Formulary based on their quality and cost. The list is kept current
through the addition, deletion or replacement of drugs to ensure plan
members have access to quality drug therapies.
The National Formulary covers 80% of the most frequently prescribed
drugs. Drugs on the list are chosen for their cost and therapeutic values.
That means new medications are routinely considered for the list but
not automatically covered.
WHY ARE DRUG PLAN COSTS RISING?
DEMOGRAPHICS – Our population is aging and as people
age they tend to use more medications.
Drugs listed on the Formulary:
70% TO 100% OF THE
COST IS COVERED
(BASED ON PLAN DESIGN)
Drugs NOT listed on the Formulary:
50% OF THE
COST IS COVERED
WHAT IF MY PRESCRIPTION IS NOT LISTED ON THE
NATIONAL FORMULARY?
Under our Formulary plans, we cover at least 50% of the cost of all
eligible drugs. If the drug your physician prescribes is not on the
Formulary, a ‘therapeutic alternative’ providing similar treatment
likely will be. With your doctor’s advice, you have two options: you
can ask your doctor to prescribe the drug that is on the formulary,
covered at 70% to 100% (based on plan design), or you can fill the
unlisted prescription and claim 50% of its cost. In either case, your
benefit plan still pays a significant portion of the expense to help
you with the cost of your prescription.
NEW DRUGS – Innovative treatment options replacing older
less effective therapies or providing treatment alternatives
for certain conditions are generally more expensive than the
drugs they are replacing.
HOW WILL MY DOCTOR KNOW WHAT TO PRESCRIBE?
PROMOTIONAL SPENDING – Over the past decade we’ve
seen an increase in the advertising and promotion of the
availability of newer medications. The ads have increased
the awareness of the options available, and at the same
time increased consumer’s expectations.
The list on the following pages provides a quick overview of the most
frequently prescribed medications. Although it is only a partial list,
it shows many drugs on the Formulary and covered at the higher
co-insurance percentage, and others not included on the Formulary
but still covered at 50%.
DOCTORS’
HEALTH LINE
Tell your doctor your drug benefit program uses the TELUS Health Solutions
National Formulary. Physicians are familiar with these types of plans.
DOCTORS WHO WANT ADDITIONAL OR MORE SPECIFIC INFORMATION
ARE WELCOME TO CALL TELUS HEALTH SOLUTIONS
TOLL-FREE AT
1 888 668 1330
This service centre can confirm whether or not a particular prescription falls under the National Formulary.
THIS PARTIAL LIST OF THE MOST FREQUENTLY DISPENSED MEDICATIONS LETS YOU SAMPLE THE FORMULARY’S COVERAGE.
“YES” MEANS THE DIN IS COVERED AT THE HIGHER CO-INSURANCE PERCENTAGE.
DIN
Name
00021474
00021695
00037605
00312770
00326844
00335053
00335061
00335088
00362166
00396788
00402796
00402818
00406716
00445282
00452130
00479799
00509558
00585114
00586668
00589861
00592277
00608165
00609129
00613215
00628123
00628158
00637742
00642215
00648035
00653276
00655759
00700401
00716626
00716839
00733059
00749354
00768715
00821772
00885436
00999999
01900978
01912070
02028700
02029421
02031094
02041421
02041456
02041464
02042479
02042487
02043394
02043408
02043440
02063662
02123274
02123282
02144263
02147637
02148587
02148765
02155907
02155990
02163926
NOVO-HYDRAZIDE 25MG TABLET
NOVO-PREDNISONE 5MG TABLET
MICRONOR 0.35MG 28 TABLET
APO-PREDNISONE 5MG TABLET
APO-HYDRO 25MG TABLET
ELAVIL 10MG TABLET
ELAVIL 25MG TABLET
ELAVIL 50MG TABLET
APO-FUROSEMIDE 40MG TABLET
APO-FUROSEMIDE 20MG TABLET
ZYLOPRIM 300MG TABLET
ZYLOPRIM 100MG TABLET
NOVAMOXIN 500MG CAPSULE
APO-SULFATRIM DS TABLET
NOVAMOXIN 250MG/5ML SUSP
ZYLOPRIM 200MG TABLET
EPIPEN 0.3MG AUTO-INJECTOR
APO-IBUPROFEN 600MG TABLET
FUCIDIN 2% CREAM
TEVA-NAPROX 500MG TABLET
APO-NAPROXEN 500MG TABLET
RATIO-OXYCOCET TABLET
DICLECTIN TABLET
TEVA-SPIRONOLACTONE 25MG TABLET
APO-AMOXI 500MG CAPSULE
APO-AMOXI 250/5ML ORAL SUSPENSION
NOVO-LORAZEM 1MG TABLET
APO-PEN-VK 300MG TABLET
TEVA-METOPROL 50MG CAPLET
RATIO-LENOLTEC NO.3 TABLET
APO-LORAZEPAM 1MG TABLET
RATIO-PREDNISOLONE 1% EYE DROPS
BETADERM 0.1% CREAM
HYDERM 1% CREAM
APO-RANITIDINE 150MG TABLET
APO-METOPROLOL (TYPE L)50MG
APO-CEPHALEX 500MG TABLET
D-TABS 10000IU TABLET
PMS-HYDROMORPHONE 2MG TABLET
EXTEMPORANEOUS MIXTURES
REACTINE 20MG TABLET
RATIO-DOMPERIDONE 10MG TABLET
TRI-CYCLEN 21 TABLET
TRI-CYCLEN 28 TABLET
LAMISIL 1% CREAM
ATIVAN 1MG TABLET
ATIVAN 0.5MG TABLET SL
ATIVAN 1MG TABLET SL
MARVELON 28 TABLET
MARVELON 21 TABLET
PREMARIN 0.3MG TABLET
PREMARIN 0.625MG TABLET
PREMARIN VAGINAL CREAM/APPL
MACROBID 100MG CAPSULE
COVERSYL 2MG TABLET
COVERSYL 4MG TABLET
TEVA-TRAZODONE 50MG TABLET
APO-TRAZODONE 50MG TABLET
ESTRACE 1MG TABLET
MYLAN-METFORMIN 500MG TABLET
ADALAT XL 30MG TABLET
ADALAT XL 60MG TABLET
TYLENOL W/CODEINE NO. 3 TABLET
Listed
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
50%
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
50%
Y
Y
50%
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
DIN
Name
Listed
02166704
02167786
02171228
02172062
02172070
02172089
02172097
02172100
02172119
02172127
02172135
02177145
02182963
02207818
02213192
02213206
02213214
02218313
02229453
02229705
02229777
02229837
02230711
02230713
02231353
02232044
02233542
02233852
02236974
02236975
02237452
02237600
02238465
02238545
02238578
02238596
02238682
02238704
02239941
02239942
02240606
02240836
02240837
02241497
02242965
02242974
02242987
02243158
02244021
02244292
02244293
02244353
02244522
02244613
02244756
02245058
02245127
02245233
02245386
02245669
02246010
02246056
02246569
PROMETRIUM 100MG CAPSULE
Y
APO-METFORMIN 500MG TABLET
Y
SYNTHROID 0.112MG TABLET
Y
SYNTHROID 0.025MG TABLET
Y
SYNTHROID 0.05MG TABLET
Y
SYNTHROID 0.075MG TABLET
Y
SYNTHROID 0.088MG TABLET
Y
SYNTHROID 0.1MG TABLET
Y
SYNTHROID 0.125MG TABLET
Y
SYNTHROID 0.15MG TABLET
Y
SYNTHROID 0.175MG TABLET
Y
APO-CYCLOBENZAPRINE 10MG TABLET
Y
APO-METHOTREXATE 2.5MG TABLET
Y
PMS-CLONAZEPAM R 0.5MG TABLET
Y
ELTROXIN 50MCG TABLET
Y
ELTROXIN 100MCG TABLET
Y
ELTROXIN 150MCG TABLET
Y
APO-ZOPICLONE 7.5MG TABLET
50%
PANTOLOC 40MG TABLET
50%
HUMALOG INSULIN CARTRIDGE/KWIKPEN
Y
PMS-BENZYDAMINE ORAL RINSE
50%
ARTHROTEC 75/200MCG TABLET
Y
LIPITOR 10MG TABLET
Y
LIPITOR 20MG TABLET
Y
MYLAN-CYCLOBENZAPRINE 10MG TABLET Y
ARICEPT 10MG TABLET
50%
DIANE-35 2MG/35MCG TABLET
50%
SYNTHROID 137MCG TABLET
Y
ALESSE 21 TABLET
Y
ALESSE 28 TABLET
Y
PERIDEX 0.12% ORAL RINSE
50%
PMS-ATENOLOL 50MG TABLET
Y
NASONEX AQ. NASAL SPRAY 50MCG
Y
ASAPHEN 80MG EC TABLET
Y
FUCIDIN H CREAM Skin disorders
Y
MYLAN-ZOPICLONE 7.5MG TABLET
50%
PLAVIX 75MG TABLET
Y
ESTROGEL .06% TRANSDERMAL GEL
50%
CELEBREX 100MG CAPSULE
50%
CELEBREX 200MG CAPSULE
50%
PMS-ZOPICLONE 7.5MG TABLET
50%
ADVAIR 250UG INHALATION DISKUS
Y
ADVAIR 500UG INHALATION DISKUS
Y
VENTOLIN HFA 100MCG INHALER
Y
AVELOX 400MG TABLET
50%
RATIO-METFORMIN 500MG TABLET
Y
DIAMICRON MR 30MG TABLET
50%
CLINDOXYL 1% TOPICAL GEL
Y
ATACAND PLUS 16/12.5MG TABLET
Y
FLOVENT HFA 125MCG INHALER (AEROSOL) Y
FLOVENT HFA 250MCG INHALER (AEROSOL) Y
NOVORAPID 100U/ML INSULIN CARTRIDGE Y
NEXIUM 40MG TABLET
50%
DETROL LA 4MG SR CAPSULE
50%
BIAXIN 500MG XL TABLET
Y
APO-OMEPRAZOLE 20MG DR CAPSULE
50%
ADVAIR 250MCG MD INHALER
Y
APO-CLINDAMYCIN 300MG CAPSULE
Y
SYMBICORT 200 TURBUHALER
Y
APO-SALVENT CFC FREE INHALER
Y
APO-METOPROLOL 25MG TABLET
Y
APO-CITALOPRAM 20MG TABLET
Y
COVERSYL PLUS 4MG/1.25MG TABLET
50%
THIS PARTIAL LIST OF THE MOST FREQUENTLY DISPENSED MEDICATIONS LETS YOU SAMPLE THE FORMULARY’S COVERAGE.
“YES” MEANS THE DIN IS COVERED AT THE HIGHER CO-INSURANCE PERCENTAGE.
DIN
Name
02246624
02246691
02246793
02246820
02247162
02247163
02247439
02247521
02247733
02247734
02247813
02247919
02248010
02248562
02248855
02250497
02251582
02251930
02252260
02252716
02252767
02253186
02255340
02256134
02257726
02258560
02258587
02261723
02261731
02263238
02263254
02265540
02267233
02268426
02268434
02268450
02269082
02270102
02271842
02272113
02273373
02273381
02274086
COVERSYL 8MG TABLET
Y
APO-HYDROXYQUINE 200MG TABLET
Y
SPIRIVA 18MCG CAPSULE
Y
SANDOZ METFORMIN 500MG TABLET
Y
CRESTOR 10MG TABLET
Y
CRESTOR 20MG TABLET
Y
SANDOZ BISOPROLOL 5MG TABLET
Y
EZETROL 10MG TABLET
50%
CONCERTA 36MG ER TABLET
50%
CONCERTA 54MG ER TABLET
50%
AVODART 0.5MG CAPSULE
50%
PMS-RAMIPRIL 10MG CAPSULE
Y
PMS-CITALOPRAM 20MG TABLET
Y
METRONIDAZOLE 500MG CAPSULE
Y
PMS-METOPROLOL-L 25MG TABLET
Y
TEVA-AMLODIPINE 5MG TABLET
Y
APO-RAMIPRIL 10MG CAPSULE
Y
LANTUS 100U/ML INSULIN CARTRIDGE
Y
VIGAMOX 0.5% OPH SOLUTION
50%
CIPRODEX OTIC SUSPENSION
Y
APO-CLOPIDOGREL 75MG TABLET
Y
NUVARING VAGINAL RING
50%
CO-AZITHROMYCIN 250MG TABLET
Y
APO-BISOPROLOL 5MG TABLET
Y
CO-METFORMIN 500MG TABLET
Y
TRI-CYCLEN LO 21 TABLET
Y
TRI-CYCLEN LO 28 TABLET
Y
YASMIN 21 TABLET
Y
YASMIN 28 TABLET
Y
CIPRALEX 10MG TABLET
Y
CIPRALEX 20MG TABLET
Y
CRESTOR 5MG TABLET
Y
TECTA 40MG EC TABLET
50%
LYRICA 50MG CAPSULE
Y
LYRICA 75MG CAPSULE
Y
LYRICA 150MG CAPSULE
Y
LIPIDIL EZ 145MG TABLET
Y
FLOMAX 0.4MG CR TABLET
Y
LEVEMIR PENFILL
Y
MYLAN-AMLODIPINE 5MG TABLET
Y
APO-AMLODIPINE 5MG TABLET
Y
APO-AMLODIPINE 10MG TABLET
Y
PMS-HYDROCHLOROTHIAZIDE
12.5MG TABLET
Y
TEVA-VENLAFAXINE XR 37.5MG ER CAPSULE Y
TEVA-VENLAFAXINE XR 75MG ER CAPSULE Y
TEVA-VENLAFAXINE XR 150MG ER CAPSULE Y
WELLBUTRIN XL 150MG TABLET
Y
WELLBUTRIN XL 300MG TABLET
Y
NOVO-BETAHISTINE 16MG TABLET
Y
TEVA-LANSOPRAZOLE 30MG CAPSULE
50%
ZOPICLONE 7.5MG TABLET
50%
PMS-AMLODIPINE 5MG TABLET
Y
TEVA-PANTOPRAZOLE 40MG TABLET
50%
APO-PANTOPRAZOLE 40MG TABLET
50%
APO-LANSOPRAZOLE 30MG CAPSULE
50%
LANTUS SOLOSTAR 100U/ML
PREFILL PEN 5X3ML
Y
APO-ATORVASTATIN 10MG TABLET
Y
APO-ATORVASTATIN 20MG TABLET
Y
APO-ATORVASTATIN 40MG TABLET
Y
APO-ATORVASTATIN 80MG TABLET
Y
02275023
02275031
02275058
02275090
02275104
02280191
02280523
02282445
02284065
02285487
02292920
02293838
02294338
02295261
02295288
02295296
02295318
FORMULARY-03-13
Listed
DIN
Name
02296640
02297795
TEVA-RABEPRAZOLE EC 20MG TABLET
GLICLAZIDE MR 30MG EXTENDED RELEASE
TABLET
RAN-RABEPRAZOLE 20MG EC TABLET
TEVA-RISEDRONATE 35MG TABLET
PMS-VALACYCLOVIR 500MG TABLET
AVIANE 21 TABLET
AVIANE 28 TABLET
AVAMYS 27.5MCG NASAL SPRAY
SANDOZ PANTOPRAZOLE 40MG TABLET
CYMBALTA 30MG DR CAPSULE
CYMBALTA 60MG DR CAPSULE
OMNARIS 50MCG NASAL SPRAY
JANUVIA 100MG TABLET
RAN-PANTOPRAZOLE 40MG TABLET
RAN-RAMIPRIL 5MG CAPSULE
RAN-RAMIPRIL 10MG CAPSULE
SANDOZ-RABEPRAZOLE 20MG TABLET
PRO-METFORMIN 500MG TABLET
PMS-CETIRIZINE 20MG TABLET
PANTOPRAZOLE 40MG TABLET
PRISTIQ 50MG ER TABLET
YAZ TABLET
COVERSYL PLUS HD 8MG/2.5MG TABLET
VAGIFEM 10 TABLET
NOVO-SALBUTAMOL HFA 100MCG/DOSE
APO-HYDRO 12.5MG TABLET
MYLAN-OMEPRAZOLE 20MG DR CAPSULE
TOLOXIN 0.125MG TABLET
APO-TRAMADOL/ACET 37.5/325MG TABLET
APO-ROSUVASTATIN 10MG
APO-ROSUVASTATIN 20MG TABLET
APO-ESOMEPRAZOLE 40MG TABLET
CO ROSUVASTATIN 10MG TABLET
CO ROSUVASTATIN 20MG TABLET
SANDOZ TAMSULOSIN CR 0.4MG
ER TABLET
MYLAN-NIFEDIPINE 30MG ER TABLET
RATIO-ATORVASTATIN 10MG TABLET
RATIO-ATORVASTATIN 20MG TABLET
VICTOZA MULTIDOSE PEN INJECTOR
AMOXICILLIN 500MG CAPSULE
METFORMIN 500MG TABLET
TEVA-ROSUVASTATIN 10MG TABLET
TEVA-ROSUVASTATIN 20MG TABLET
DEXILANT 60MG CAPSULE
SANDOZ-VALSARTAN 80MG TABLET
SANDOZ-VALSARTAN 160MG TABLET
PRADAX 150MG CAPSULE
VIMOVO 500MG/20MG TABLET
PATADAY 0.2% OPH SOLUTION
APO-CANDESARTAN 16MG TABLET
PANTOPRAZOLE 40MG TABLET
SANDOZ TELMISARTAN 80MG TABLET
PMS-ROSUVASTATIN 10MG TABLET
RAN-ROSUVASTATIN 10MG TABLET
METHADONE SOLUTION ODB
ONE TOUCH ULTRA BLUE TEST STRIP (ON)
CONTOUR TEST STRIP (ON)
02298082
02298392
02298457
02298538
02298546
02298589
02301083
02301482
02301490
02303671
02303922
02305046
02310538
02310546
02314185
02314908
02315963
02318695
02321092
02321157
02321653
02325462
02326450
02327856
02329433
02335719
02336790
02337983
02337991
02339102
02339773
02339781
02340208
02349167
02350297
02350319
02351064
02352729
02353377
02354616
02354624
02354969
02356759
02356767
02358808
02361728
02362171
02365367
02370808
02375966
02378531
02382652
09850619
09854290
09857127
Listed
Y
50%
Y
Y
Y
Y
Y
Y
50%
50%
50%
Y
50%
50%
Y
Y
Y
Y
50%
50%
50%
Y
50%
Y
Y
Y
50%
Y
50%
Y
Y
50%
Y
Y
Y
Y
Y
Y
50%
Y
Y
Y
Y
50%
Y
Y
50%
50%
50%
Y
50%
Y
Y
Y
Y
Y
Y

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